Steep Copayments Increase Risk of Non-Adherence

Higher out-of-pocket drug costs delay initiation of therapy for patients with chronic conditions
By Rick Ansorge
HealthDay Reporter

TUESDAY, April 28 (HealthDay News) -- In patients who are newly diagnosed with a chronic disease, higher out-of-pocket costs for medications are associated with an increased likelihood of non-treatment, according to a study published in the April 27 issue of the Archives of Internal Medicine.

Matthew D. Solomon, M.D., of the Stanford University School of Medicine in California, and colleagues studied 17,183 older adults with private health insurance who were newly diagnosed with hypertension, diabetes or hypercholesterolemia between 1997 and 2002.

The researchers found that patients with higher copayments were more likely to delay treatment, and their survival model predicted treatment rates five years after diagnosis would be significantly lower among patients with doubled copayments (66.2 percent versus 81.6 percent for hypertension, 53.8 percent versus 64.3 percent for hypercholesterolemia, and 62.9 percent versus 69.3 percent for diabetes, respectively). They also found that prescription-naive patients were significantly more price sensitive and more likely to delay treatment than those who had used prescription drugs.

"What do these provocative findings mean? For policymakers, it means that blunt instruments such as cost sharing lead to blunt effects, both intended (drug cost savings) and unintended (delays in the initiation of treatment and other forms of cost-related non-adherence that lead to suboptimal health and perhaps to increased total costs). For physicians, it means acknowledging that 10 to 20 percent of patients never fill our prescriptions and that we need to pay more attention to out-of-pocket costs and discuss them at every opportunity," states the author of an accompanying editorial.

A co-author of the study reported financial relationships with the pharmaceutical and medical equipment industry.

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